Aspirin Dosing for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Chronic Obstructive Pulmonary Disease and Asthma: Insights From ADAPTABLE.

BACKGROUND: Guidelines recommend aspirin (75-100 mg daily) for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD). However, it is unknown if people with a history of ASCVD and chronic obstructive pulmonary disease (COPD) or asthma, which are independent risk factors for ASCVD, would benefit from higher dose aspirin. METHODS: We evaluated the effectiveness and safety of 2 aspirin doses among individuals with and without COPD/asthma in the ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) trial. The ADAPTABLE study was an open-label, randomized clinical trial that assigned people with ASCVD to aspirin 81 or 325 mg. We performed a secondary analysis of data from the ADAPTABLE study to investigate the difference in clinical effectiveness and safety among people with and without COPD or asthma randomized to aspirin 325 versus 81 mg. We assessed if history of COPD/asthma modified the association between aspirin dose and outcomes. RESULTS: Among the 14 662 participants, 2778 had a history of COPD or asthma and 11 884 had no history of COPD or asthma. We observed no significant interaction between aspirin dose and history of COPD/asthma in our adjusted primary composite outcome (adjusted hazard ratio [aHR], 1.15 [95% CI, 0.92-1.43]; P value=0.349). We observed individuals with a history of COPD/asthma treated with aspirin 81 mg had a significantly higher risk of stroke (aHR, 2.41 [95% CI, 1.27-4.57]) compared with a treatment strategy of aspirin 325 mg. CONCLUSIONS: Among people with ASCVD and COPD/asthma, there were no significant differences in ASCVD outcomes based on aspirin dosing except stroke. Further evaluation of stroke prevention in this population is warranted.

Duke Scholars

Author Adrian Felipe Hernandez Medicine, Cardiology

Author William Schuyler Jones Medicine, Cardiology

Author Lisa Wruck Biostatistics & Bioinformatics, Division of Biostatistics

Author Christopher Mosher Medicine, Pulmonary, Allergy, and Critical Care Medicine